Healthcare Provider Details

I. General information

NPI: 1790732535
Provider Name (Legal Business Name): ACCUSCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PRISCILLA LN
CHESAPEAKE VA
23322-3735
US

IV. Provider business mailing address

900 PRISCILLA LN
CHESAPEAKE VA
23322-3735
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-8120
  • Fax: 757-546-0653
Mailing address:
  • Phone: 757-773-8120
  • Fax: 757-546-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number71736
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number36302
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number106459
License Number StateVA

VIII. Authorized Official

Name: TERESA L LILLY
Title or Position: PRESIDENT
Credential:
Phone: 757-773-8120